title: Effective behavior change techniques in asthma self-care interventions: systematic review and meta-regression.
abstract: OBJECTIVE
  The purpose of this study is to update previous systematic reviews of interventions targeting asthma self-care in adults with asthma, and to use meta-regression to examine the association between the use of specific behavior change techniques and intervention effectiveness.
  
  
  METHODS
  Electronic bibliographies were searched systematically to identify randomized controlled trials of interventions targeting asthma self-care. Intervention content was coded using a published taxonomy of behavior change techniques. For trials with a low-to-moderate risk of bias, study outcomes were pooled using random effects meta-analysis. Associations between intervention content and effect size were explored using meta-regression.
  
  
  RESULTS
  Meta-analysis of 38 trials (7883 patients) showed that interventions targeting asthma self-care reduced symptoms (standardized mean difference [SMD] = -0.38 [-0.52, -0.24]) and unscheduled health care use (odds ratio [OR] = 0.71 [0.56 to 0.90]) and increased adherence to preventive medication (OR = 2.55 [2.11 to 3.10]). meta-regression analyses found that "active involvement of participants" was associated with a reduction in unscheduled health care use (OR = 0.50 vs. 0.79). Inclusion of "stress management" techniques was associated with an increase in asthma symptoms (SMD = 0.01 vs. -0.44). Existing recommendations about the "optimal" content of asthma self-care interventions were tested but were not supported by the data.
  
  
  CONCLUSIONS
  Interventions targeting asthma self-care are effective. Active involvement of participants is associated with increased intervention effectiveness, but the use of stress management techniques may be counterproductive. Taxonomy-based systematic reviews using meta-regression have potential for identifying techniques associated with increased effectiveness in behavioral interventions.
authors.affiliation: University of Exeter Medical School, Institute of Health Services Research, University of Exeter.
authors.forename: Sarah
authors.initials: S
authors.lastname: Denford
authors.affiliation: University of Exeter Medical School, Institute of Health Services Research, University of Exeter.
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
authors.affiliation: Primary Care Research Group, University of Exeter Medical School, University of Exeter.
authors.forename: John L
authors.initials: JL
authors.lastname: Campbell
authors.affiliation: Primary Care Research Group, University of Exeter Medical School, University of Exeter.
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Greaves
mesh_terms: D000328:Adult; D001249:Asthma / Q000523:psychology / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012648:Self Care / Q000523:psychology*